What is it
A mature teratoma develops from a germ cell that has retained the ability to form different types of tissue. Inside the cavity, fatty contents, hair, areas of skin with sebaceous glands, less often teeth, bone and cartilage tissue, and elements of nervous tissue are found. The cyst wall is dense, so the formation is well demarcated from the ovary. Most often, teratomas are unilateral, but in approximately every tenth woman they occur on both sides. They grow slowly, on average by a couple of millimeters per year, and almost always remain benign.
- Mature teratoma is a benign tumor
- Contains fat, hair, skin, sometimes teeth
- Most often unilateral
- Grows slowly, does not disappear on its own
- Malignant degeneration is rare
- Detected at any age, most often at 20–40 years of age
Causes and risk factors
The exact reason is unknown. It is believed that a dermoid cyst occurs due to a violation of reproductive cell division at an early stage of development, so it cannot be prevented by lifestyle, nutrition or contraception. Hormonal disorders and inflammation of the ovaries have nothing to do with its appearance. The only factors that influence the likelihood of complications are the size of the formation and the mobility of the ovary: the larger the cyst, the higher the risk of torsion, especially during physical activity and during pregnancy.
- Violation of germ cell division
- Not associated with hormonal imbalances and inflammation
- Does not depend on nutrition and lifestyle
- The risk of torsion increases with sizes greater than 5 cm
- Pregnancy increases the likelihood of complications
- Familial cases possible, but rare
Symptoms
Small cysts do not manifest themselves in any way and do not affect the menstrual cycle - this is an important difference from functional cysts. As you grow, a nagging pain or feeling of heaviness in the lower abdomen on one side and discomfort during physical activity and sexual intercourse appear. A large cyst can put pressure on the bladder and rectum, causing increased urination and constipation. Sharp, sudden pain indicates a complication: a torsion of the leg or a rupture, in which case emergency assistance is required.
- Most often there are no complaints
- Nagging pain in the lower abdomen on one side
- Feeling of heaviness and fullness
- Frequent urination, constipation with large sizes
- The cycle is usually not broken
- Sudden sharp pain due to torsion or rupture
Diagnostics
The main method is pelvic ultrasound, preferably transvaginal. A dermoid cyst has a characteristic appearance due to fatty contents and dense inclusions, so an experienced specialist will recognize it quite confidently. In case of doubt or large size, an MRI of the pelvis is prescribed, which clearly distinguishes fat and clarifies the connection with neighboring organs. Tumor markers are used selectively, since they can also be elevated in benign conditions. Sometimes teratoma inclusions are accidentally found on x-rays or CT scans performed for another reason.
- Ultrasound of the uterus and ovaries, transvaginal access
- MRI of the pelvic organs with an unclear picture
- Tumor markers according to indications
- Examination by a gynecologist
- Observation in dynamics at small sizes
Treatment
There is no conservative treatment: hormones, physiotherapy and herbs have no effect on dermoid cysts. Small formations can be observed without complaints by monitoring the size on ultrasound. Indications for surgery are size more than 5 cm, height, pain, planning pregnancy and the inability to exclude another tumor. The standard is laparoscopic cystectomy: the cyst is enucleated, preserving as much healthy ovarian tissue as possible, which is important for future fertility. The surgeon tries not to damage the capsule so that the contents do not enter the abdominal cavity. In case of torsion or rupture, the operation is performed urgently.
- Observation for small asymptomatic cysts
- Laparoscopic cyst removal with ovarian preservation
- Gentle extraction without opening the capsule
- Histological examination of removed tissue
- Emergency surgery for torsion and rupture
- Removal before pregnancy when planning
- Control ultrasound after surgery
